Discussions that mention tylenol

Pain Management board

They are 5mg/325mg Tylenol. I've been with him for 3.5 years. He said it would be b/c of liver damage. I've asked him for the same dug w/out the Tylenol, and he insists it doesn't exist (although I know of several on here who take it.) I only live in Canada, so I'm sure we have it here. No pain doc's though, so this is just a family doctor.
You can be upped to percocet 10/325. Same amount of tylenol, but twice the oxycodone. It sounds like an excuse to me. Do you take a long-acting med? That would be the best thing for you. You could talk to your doctor about long-acting oxycodone (Oxycontin), with percocet for break-thru pain. Your tolerance increases faster with short-acting meds, and you have the "roller-coaster" effect of pain. This doc sounds like he is not doing his best by you, in my opinion.
6 Percs would mean 1950gr amt of Tylenol a day. The max amt is 4000gr daily, but long time use is 2800mg daily (I heard this hearsay only...do not quote me)...so I agree with the post above. It sounds like an excuse. It surprises me since he has been your doctor for so long.
Be careful asking for the 10mg. He does not sound like he is really on your same wave length right now and asking for that may seem like you are directing your care, not him. Not sure what to offer for advice here. Building up a tolerance is totally normal, so maybe if you ask for a liver enzyme test monthly along with a small increase in the amt you can take??
Let us know what happens. and good luck
be well
Well I know for a fact that you haven't maxed out on the Percosets. I take the #10/325-up to 6 a day. I was taking 8, but they(whoever they are) now have findings that say that that much is "too" much. I gather they are talking about the Tylenol, not the Percoset. I also have the 5mg percoset IRs for breakthrough, and I am on slow release morphine.

Don't know about the end of the road. As many new medical things are being developed, we may not need larger quantities of drugs....wouldn't that be a delight. Good luck with finding better ways to control the pain...sounds like you need a change of doctors.
ZuZu, You have a GP managing chronic pain. If you need a PM doc then you may have to travel or relocate. As far as the percs, your on step two of dozens of options with long acting versions of oxy, morphine, fentanyl patches, methadone, long acting dilaudid, short acting dilaudid and you are corect, Purdue makes OxyIR in 10 and 20 mg tablets that contain no tylenol. However you can't really expect your GP to manage CP that requires meds that would have only been prescribed for cancer just 10 years ago. All the LA meds and the high strength pure opiates have all come out in the last 5-10 years, Newer ones hit the market each year. You simply can't expect a GP to be versed in PM and all the alternatives.

So what happens when you tolerant to 600 mgs of long acting morphine a day and 30 mg Oxycodone tablets barely touch the pain? You can have an intrathecal morphine pump implanted, that's when no other method of pain management is effective or the side effects of other meds are too severe to manage your problem. It sounds like the only method of pain management you have been exposed to is the pain meds your GP is willing to prescribe. Prior to 96 and the invention of long acting pure opiates, PM docs used other methods to manage pain, some help, some are a waste of time and some resolve some peoples roblems entirely.

You have to look at this as how your going to spend the rest of your life. If you had cancer, you wouldn't except a death sentance from your loocal GP because he was trained in oncolog., You're basically facing the same thing. Honestly , you probably shouldn't jump on the increrase train and jack your tolerance through the roof untill you have explored some options that don't result in dependence on opiates.

There really is no ceiling on the amount of pure opiate one person can take. The ceiling is created by the side effects, Too sedating, too much urinary retention, too constipating, too much nausea, or the docs own discomfort with high dose patients. Side efects do deminish with time, a couple of increases in morphine and some time to adjust to the side effets may have allowed morphine to be a viable option. However, your doc claims not to even be aware they make a drug stronger than percs, so it's time to start looking into real PM if you need these meds to function.

It's not like these meds are harmless though, There is a price to be paid for everything. Physical dependence is a huge priice, and dependence on 6 percs a day is nothing compared to seveeral hundred mgs of long acting pure opiate.

600 mgs of morphine may sound like alot, but it's the difference between being able to walk and being bed ridden for me, It's not a matter of comfort. There is no dose that would eliminate all my pain or even rekieve more than half my pain without sedating me. Honestly there are days I wish I could be sedated. All you have done is see the limits of your own GP and know you need a specialist if you can't manage with what he has to offer.

Even among PM docs, not every doc can offer every modality.Some use opiates, some don't,some do interventional procedures and some simply write scripts. There are dozens of non opiate methods to manage chronic pain. Opiates are the easiest solution, but come with a huge price. In Canada, you have to have a special licence to prescribe methadone which can be very effective, It's not the next step on the ladded but it's something out there your present doc will never be able to offer. He'll never offer an implanted morphine pump or a spinal cord stim, can he teach you self hypnsosis, Bio feedback or guided imagry? Does he use anti seizure meds and anti depressant for their chemical effect.

The same goes for techniques uswed by real PM docs. Not every PM doc can or will offer Interventional procedures like nerve blocks, epidurals, trigger point injections, use of Botox or even surgery if that may bring relief. Your doc isn't a PM doc so he will not be offering anything he's not familiar with. If you needed surgery or had cancer, he would admit his limitations, He's simply not comfortable prescribing more than 6 percs a day. He does want to say that's his personal limit, he's just saying he won't prescribe more than that.

That's his choice, but you have the option of seeking more qualified help.
If someone will only participate in PM if it's conveinant, doesn't interfer with their life or have to drive more than 30 minutes, It's hard to call that life altering pain that requires the most potent meds and most agressive methods to treat pain. If your pain is that severe, you will travel or be bed ridden or simply more uncomfortable than you are now once you grow more tolerant.

The only real limit you have run into so far is local doc selection and his willingness to prescribe stronger meds. Perhaps he wants you to go find a PM doc with a background in anesthesia so he can try some of the non opiate interventional procedures. Traveling sucks, but it's better than allowing pain to manage your life rather than you manging the pain.

It's not that your docs a bad guy, He just doesn't want to test his prescribing limits on the few patient he may presently be helping. If percs are the strongest thing he uses, I kind of doubt he's going to prescribe fentanyl loli pops that are a hundred times more potent than percocet.

Good luck and you may be surprised by all the options true PM docs can offer.
Take care, Dave
ZuZu, I also live in Alberta and yes there is a form of oxycodone with no tylenol, iburprofen etc. It's called oxyir. I was on it up until a few months ago. I'm not sure how strong the doseage goes to though the only ones I've been on are the 5mgs and the 10mgs but I'm sure they go higher.
Usually given for breakthrough pain, Oxycodone or Oxy IR is pure Oxycodone. There is no Tylenol or anything in it. It is available in the US in 5, 15, and 30 mg doses. There are generics available.

There isn't a ceiling on opiate meds as several posts have indicated. It just depends on what you are able to tolerate, as far as side effects go. The higher the dose, usually means an increase in side effect problems occurring.
Hey Zuzu: As I said in my earlier post, there isn't a ceiling when it comes to "pure" opiates. By that, I'm talking (as I said before) about pure Oxycodone. It's called Oxy IR. Same as Percosets, but without the apap (Tylenol) which damages your liver. The only thing that would be a problem, is if you got to a certain dose and your body just had too many side effects to continue taking the medication. In other words you aren't able to go any higher. That doesn't mean you couldn't be changed to another med that you could tolerate and it would cover your pain.

I hope you can understand and make some sense out of all this that I'm trying to explain to you.